A 29-year-old primigravida at 32 weeks gestation presents with BP 158/106 mmHg, 3+ proteinuria, and severe headache. Platelet count is 92,000/µL, AST 110 U/L, serum creatinine 1.4 mg/dL. Which combination of findings best defines 'severe features' of pre-eclampsia in this patient?
- A BP ≥140/90 mmHg with 3+ proteinuria alone
- B Proteinuria >500 mg/24h with pedal edema
- C BP ≥160/110 mmHg with thrombocytopenia and elevated liver enzymes ✓
- D Any elevation of BP with fetal growth restriction
Correct answer: C. BP ≥160/110 mmHg with thrombocytopenia and elevated liver enzymes
Explanation
Severe features of pre-eclampsia per ACOG criteria include systolic BP ≥160 or diastolic ≥110 mmHg on two readings 4 hours apart, thrombocytopenia (<100,000/µL), impaired liver function (elevated transaminases to twice normal), progressive renal insufficiency (creatinine >1.1 mg/dL), pulmonary edema, new-onset headache, or visual disturbances. Proteinuria quantity alone does not define severity; significant proteinuria (previously ≥5 g/24h) has been removed as a severe-feature criterion by ACOG 2019 guidelines.
Reference: Williams Obstetrics, 26th ed.
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